title: Influence of continuous positive airway pressure on outcomes of rehabilitation in stroke patients with obstructive sleep apnea.
abstract: OBJECTIVE
  In stroke patients, obstructive sleep apnea (OSA) is associated with poorer functional outcomes than in those without OSA. We hypothesized that treatment of OSA by continuous positive airway pressure (CPAP) in stroke patients would enhance motor, functional, and neurocognitive recovery.
  
  
  METHODS
  This was a randomized, open label, parallel group trial with blind assessment of outcomes performed in stroke patients with OSA in a stroke rehabilitation unit. Patients were assigned to standard rehabilitation alone (control group) or to CPAP (CPAP group). The primary outcomes were the Canadian Neurological scale, the 6-minute walk test distance, sustained attention response test, and the digit or spatial span-backward. Secondary outcomes included Epworth Sleepiness scale, Stanford Sleepiness scale, Functional Independence measure, Chedoke McMaster Stroke assessment, neurocognitive function, and Beck depression inventory. Tests were performed at baseline and 1 month later.
  
  
  RESULTS
  Patients assigned to CPAP (n=22) experienced no adverse events. Regarding primary outcomes, compared to the control group (n=22), the CPAP group experienced improvement in stroke-related impairment (Canadian Neurological scale score, P<0.001) but not in 6-minute walk test distance, sustained attention response test, or digit or spatial span-backward. Regarding secondary outcomes, the CPAP group experienced improvements in the Epworth Sleepiness scale (P<0.001), motor component of the Functional Independence measure (P=0.05), Chedoke-McMaster Stroke assessment of upper and lower limb motor recovery test of the leg (P=0.001), and the affective component of depression (P=0.006), but not neurocognitive function.
  
  
  CONCLUSIONS
  Treatment of OSA by CPAP in stroke patients undergoing rehabilitation improved functional and motor, but not neurocognitive outcomes.
  
  
  BACKGROUND
  URL: http://www.clinicaltrials.gov. Unique identifier: NCT00221065.
authors.affiliation: Toronto Rehabilitation Institute, University of Toronto, Ontario, Canada. clodagh.ryan@uhn.on.ca
authors.forename: Clodagh M
authors.initials: CM
authors.lastname: Ryan
authors.forename: Mark
authors.initials: M
authors.lastname: Bayley
authors.forename: Robin
authors.initials: R
authors.lastname: Green
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Murray
authors.forename: T Douglas
authors.initials: TD
authors.lastname: Bradley
mesh_terms: D000368:Aged; D045422:Continuous Positive Airway Pressure / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D020127:Recovery of Function / Q000502:physiology; D016037:Single-Blind Method; D020181:Sleep Apnea, Obstructive / Q000150:complications / Q000503:physiopathology* / Q000534:rehabilitation*; D020521:Stroke / Q000150:complications / Q000503:physiopathology*; D000071939:Stroke Rehabilitation; D016896:Treatment Outcome